Why we think NICE should change their decision on enzalutamide

Why does good news always have to be followed by bad? It’s great news for men with advanced prostate cancer that the new drug enzalutamide is being recommended for use on the NHS but frustrating that it’s being limited to men who haven’t already have abiraterone.

The National Institute of Health and Care Excellence's (NICE) recent draft decision will come as a huge disappointment to those men for whom abiraterone hasn’t worked, as they learn they’ve reached the end of the road in terms of possible treatments. This is a real step back from NICE’s original draft recommendations to make enzalutamide available to all men whose prostate cancer has become resistant to hormone therapy and chemotherapy, Let’s be clear, if a man with late-stage prostate cancer has become resistant to hormone therapy and also tried chemotherapy, there aren’t a lot of treatment options left. But the new drugs enzalutamide and abiraterone do offer hope – hope of extra months of life and reduced pain. Think about how much it can mean to a man and his family to have precious extra time together. What NICE’s decision effectively does is remove one of these options from an already almost empty bag. And from what we can see, without justifiable cause. The reason that there is no data to show specifically how enzalutamide works after abiraterone – is not going to stand up when talking to a man who is desperate for extra months of life to spend with his family and wants the option to see if that treatment will work for him. In NICE guidelines for treating prostate cancer, a lot of emphasis is put on informed choice, shared-decision making – and prescribing treatment and care that suits the individual’s situation and preferences. But if this decision goes ahead, there is a real dilemma facing doctors, where the wrong choice could limit a man’s options later down the line, or push him down a path that might not be right for him. What makes the decision even harder to digest is that in Scotland enzalutamide is available to men without the same restriction around abiraterone. Why should men in one part of the UK be denied the hope given to men in another? We appreciate that NICE have difficult decisions to make about access to treatments, and that many competing factors must be weighed up in making recommendations - but this restriction makes no sense to us. We want to see this restriction removed, and we need your help. Please share your views with NICE and help us fight this. In the words of one man affected by this decision, "Living with this disease is hard and emotional enough without having to worry whether or not we can be given drugs than can benefit us."